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Tuesday, March 27, 2012

Three Hundred Per Cent

As a doctor currently training in the fabulous speciality of obstetrics, (with a background in the even more fabulous specialty of General Practice) your correspondent stands on the hallowed ground halfway between medicine and surgery.

In that while she performs a great deal of surgery in her day to day life, she still has the ability to mock surgeons (gently of course, as they are her rather friendly and useful colleagues).

Thus how the following adventurous tale of Dr. Robert Liston first came to her ears.

Dr. Liston was a Scotsman, born in 1794 and from his description sounds like quite a character. In a pre-anaesthetic era speed of surgery was a patient's only hope to avoid pain and infection. Liston was famous for removing a 20 kilogram scrotal tumour in 4 minutes.

Rather than try to describe the man myself, I will let his contempory, Dr. Richard Gordon, do so for me:

"He was six foot two, and operated in a bottle-green coat with wellington
boots. He sprung across the blood-stained boards upon his swooning,
sweating, strapped-down patient like a duelist, calling, 'Time me
gentlemen, time me!' to students craning with pocket watches from the
iron-railinged galleries. Everyone swore that the first flash of his
knife was followed so swiftly by the rasp of saw on bone that sight and
sound seemed simultaneous. To free both hands, he would clasp the bloody
knife between his teeth."

Liston was an imposing and acerbic fellow. He left Edinburgh, where he had trained and practiced throughout his early career, in 1834 principally because he was so unpopular in the medical community there. Not least of that was due to knocking down the infamous anatomist Dr. Knox in front of his students. He assumed that some of the students had slept with the young woman being dissected while she was alive and that their behaviour was voyeuristic. (As it turned out there was even worse foul play at foot!)

However, his somewhat abrasive personality was not always in the best interest of patients. In one of the most famous cases associated with his name, Dr Liston was involved in an argument with a junior doctor about whether a mass on a boy's neck was a carotid artery aneurysm (a large swelling of a blood vessel) or an abscess (an infection). Dr. Liston proceeded to settle the argument by removing his scalpel and lancing the mass there and then. The young boy bled to death in a matter of minutes.

The remainder of Liston's career was spent in London, where he pioneered some amazing accomplishments, including the first British operation under anaesthesia in 1846. A leg amputation, performed in 28 seconds, which of course makes one wonder if anaesthesia was required at all.

(in this photo Joseph Lister is actually the gentleman on the top left - I may be geeking out slightly.)

He also invented the Bulldog artery forceps. I used a variation of them the other day.

But this is, of course, not why I am telling this story.

Legend has it that one day Dr. Liston was performing an amputation. He proceeded to do so in his usual 2 and a half minutes but in his enthusiasm also amputated the fingers of his young surgical assistant, and cut through the coattails of a distinguished spectator who had leaned in too close.

The spectator perished from fright instantly, the patient a few days later from overwhelming infection, and the assistant a few days after that, also from infection.

It remains the only operation in history with a three hundred percent mortality rate.

As I tell my surgical colleagues - they've got a lot to live up to ;).